ADHD in Adulthood
So, you’re wondering if you or someone you know has ADHD as an adult. Perhaps you or they do, but before we get into all the details, we need to cover a couple “housekeeping items.”
First, a word to the wise…
My Abnormal Psychology (undergraduate) and Psychopathology (graduate) class professors each provided warnings to students before we even opened our textbooks or the Diagnostic and Statistical Manual of Mental Disorders (DSM).
To paraphrase, they basically said everyone may see themselves in just about every diagnosis (set of symptoms) including us students. Yep – I saw a lot of myself in some of the diagnostic criteria and sometimes still do!
But – the warning continued – just because you have symptoms of some things does not mean you have a disorder or something diagnosable! Basically, using this information alone would be similar to Googling physical symptoms and everything pointing to “cancer.” As you logically know, most symptoms do not actually result in a cancer diagnosis, yet it is important to discuss your symptoms and concerns with a qualified professional.
When diagnoses are given by a qualified professional, it’s typically not only because an individual has sought help for a set of symptoms they’re experiencing, but it’s also because the symptoms have persisted for a period of time and are causing some disruption to or dysfunction in their lives. The diagnosis aids in understanding of the experience, treatment planning, and (in many cases) access to coverage for treatment.
Please take this into consideration before diagnosing yourself. 😊
Another wise thing to take into consideration is this:
In 2000, the average human attention span was 12 seconds; in 2013 the average dropped to 8 seconds. Goldfish actually have longer attention spans (9 seconds) than humans do now.
Why? Our world is changing, and our attention span is following suit. In general, we are skimming for quick information, looking for quick fixes, and handling things more rapidly (sometimes with mistakes or distractions). All that to say, it’s taking more to capture and keep our attention. Essentially, we seem to need quicker access to information or faster ways to complete the task/resolve the issue, otherwise we’re moving on to another resource or something else altogether.
The main takeaway here: having a shorter attention span nowadays is not necessarily something that is unique to ADHD; it’s a collective experience effected by multiple factors. Keep this in mind.
One last note:
Most of us will have moments of daydreaming, auto-pilot, forgetfulness, “zoning out,” boredom, procrastination, and so on. This is totally normal and can be an adaptive function that your brain is doing for a reason or a behavioral issue which may have some remedies. It can be helpful to take perspective as to your experience by talking with trusted family members, friends, colleagues, etc., to see how “normal” or “abnormal” your experience may be.
Alright, on to the reason why you’re here.
For purposes of keeping your attention or answering your questions as you skim through this post, I’ve broken the information down into FAQ style presentation. 😉
ADHD in Adulthood: The Basics
What is ADHD anyway?
ADHD stands for Attention-Deficit/Hyperactivity Disorder (formerly known as Attention-Deficit Disorder or ADD). It is a neurological disorder which affects thinking and behaviors. The symptoms are present, more days than not, for an extended period of time and cause difficulties in various aspects of life.
But wait. Isn’t ADHD a childhood thing?
Yes and no.
ADHD symptoms begin in childhood. Sometimes it’s caught and treated with therapy and/or medication, but sometimes the signs and symptoms are missed and instead may be chalked up to “bad behavior,” “chattiness,” “school refusal,” “being lazy,” and a number of other things. There’s a large stigma associated with mental health conditions, and particularly ADHD, and sometimes parents may intentionally or unintentionally not get the root cause of ADHD identified and treated.
In many cases, children will “outgrow” ADHD. In other words, the symptoms reduce or become more manageable over time. In some cases, though, the ADHD symptoms persist into adulthood – they may just appear differently than we would think.
For adults who never received an ADHD diagnosis in childhood, they may be struggling and not realize that their symptoms align with ADHD in adulthood. Sometimes this is because “this is the way it’s always been” for them, or because they may think what they’re experiencing is anxiety, depression, or something else (and it could also be that in addition to ADHD).
Mmmk, so how common is ADHD in adulthood?
ADDitude reported the following estimates they gathered from a few sources:
4.4% (estimated) of U.S. adults are diagnosed with ADHD. That’s about 8 million adults.
It is more commonly diagnosed in men (5.4%) than in women (3.2%).
ADHD persistence rates from childhood to adulthood has a huge range, from 6 to 30% (so this data point alone may not be reliable).
Adult ADHD diagnoses have risen in the past decade.
Less than 20% of adults who experience ADHD symptoms have sought diagnosis or treatment.
Of that 20%, only about 25% of them seek help.
In other words, it is likely that a large number of adults meet criteria for ADHD, are living (or struggling) with the symptoms, and have not yet been diagnosed nor treated for ADHD.
What are the symptoms of ADHD?
I may lose you here – because it’s a lot of information to process – but I’m going to give you the info from the Diagnostic and Statistical Manual for Mental Disorders (DSM for short, currently version 5). The DSM is the manual clinicians use for identifying groups of symptoms and confirming if diagnostic criteria are met and to what extent.
There are three types of ADHD:
Predominantly Inattentive Type,
Predominantly Hyperactive/Impulsive Type, and
Mixed or Combined Type (where criteria for both are met)
The DSM-5 identifies the criteria for ADHD as follows (somewhat shortened for brevity):
A. A persistent pattern of inattention and/or hyperactivity-impulsivity which interferes with functioning or development, as characterized by (1) and/or (2):
1. Inattention: Six (6) or more of the following symptoms for children or five (5) or more symptoms for adults, persisting for at least six months, which are not consistent with the individual’s developmental level, and negatively impacts functioning (such as academic, occupational, social, or daily tasks)
a. Difficulty paying attention to detail or making careless mistakes
b. Difficulty maintaining attention during lectures, conversations, reading, or other activities
c. Appearing/feeling absent-minded as if the mind was “somewhere else” when directly spoken to, even in the absence of identifiable distractions
d. Often does not follow-through or complete tasks, chores, or assignments due to difficulty focusing or getting sidetracked)
e. Often has trouble managing time or organizing tasks/materials/belongings
f. Dislikes or avoids tasks or activities which require sustained mental effort or focus
g. Often misplaces/loses items that are necessary for daily activities or school/work
h. Experiences frequent distractions by irrelevant stimuli (this could be thoughts)
i. Experiences frequent forgetfulness in daily activities or necessary tasks/appointments
2. Hyperactivity/Impulsivity: Six (6) or more of the following symptoms for children or five (5) or more symptoms for adults, persisting for at least six months, which are not consistent with the individual’s developmental level, and negatively impacts functioning (such as academic, occupational, social, or daily tasks)
a. Often fidgets with things, taps hands/feet, squirms in seat
b. Often gets up out of seat and moves around when situations expect one remains seated
c. Often runs around, climbs on things, or feels excessively restless
d. Often finds it difficult or nearly impossible to engage in activities quietly
e. Feels “on the go” frequently and may be uncomfortable sitting still or relaxing
f. Often talks excessively, whether socially or in settings where one is expected to be listening
g. Often blurts out answers, comments, or projects what another person is going to say before they’re done speaking
h. Has difficulty waiting in lines or waiting for their turn
i. Often interrupts others or may intrude on common boundaries (such as taking over an activity or using someone else’s items without getting permission first)
B. Several of the symptoms in either (1) or (2) were present before age 12.
C. Several of the symptoms in either (1) or (2) occur in two or more settings (e.g., school/work, home, family life, social life).
D. The symptoms interfere with daily functioning or reduce the individual’s quality of life.
E. The symptoms are not better explained by another mental disorder or substance use.
Okay, so criteria are met but how bad is it?
An individual may experience the minimum symptoms necessary for diagnosis, or they may experience nearly all the symptoms. Because of this, ADHD diagnoses will also be assessed for severity level. The individual’s experience may vary from mild to severe.
Mild – Few, if any, additional symptoms are experienced beyond the minimum necessary for diagnosis, and the symptoms result in minor difficulties in functioning.
Moderate – Symptoms or impairments fall between Mild and Severe.
Severe – Many symptoms in excess of the minimum required are present, and/or the symptoms result in severe difficulties or impairment in functioning.
This is a lot of info. How does all of this really look in adulthood?
When we think of ADHD, we often have the idea of the child who “can’t sit still” in class, blurts out answers, interrupts, and so on. In adulthood, things may look a little different.
In childhood, adults with ADHD may have experienced:
Not performing well in school
Having to repeat a grade
Difficulty managing time or turning in work on-time
Reprimands for not following rules or misbehaving in class
Discipline for not sitting still/staying in seat, excessive talking, interruption, blurting out answers, etc.
Dropping out of school
Adults with ADHD may experience difficulties with:
Paying attention to details
Organizing tasks or belongings
Finishing work on-time
Remembering to do necessary tasks, like paying bills on time
Job dissatisfaction, boredom, or lack of desired successes
Regulating emotions or managing changing moods/angry outbursts
Difficulty managing money or managing impulse-buying
Engaging in risky behavior, speeding, or getting into accidents
Staying “checked in” during conversations
Maintaining healthy relationships
Each person’s experience is going to vary. Also, be sure to keep those things I mentioned in the beginning in mind.
Could these symptoms be the product of something physical health-related?
Of course, it’s possible that these symptoms could be better explained by something else. Our thoughts and behaviors are absolutely impacted by our physical and mental health. Lots of things, such as hormone imbalances, thyroid issues, sleep disorders, other mental health conditions, other learning disabilities, and more can cause difficulties with attention and behavior. I always recommend that you talk with your medical doctor about your symptoms to ensure there isn’t another underlying cause for ADHD (or other) symptoms. Your doctor will be able to run some blood tests and other diagnostics to rule out any physical health causes.
Could my symptoms actually be another mental health condition?
Certainly. Some of the ADHD symptoms can be better explained by other mental health conditions, such as anxiety or depression. Anxiety, for instance, can have racing thoughts which can lead you to feel “checked out” and miss key information or make careless mistakes. Depression, for instance, can have low motivation and a “brain fog” of sorts. It’s always important to have other mental health disorders checked out to rule in or out other conditions. On that note, other mental health conditions can occur with ADHD.
Can I have ADHD and another mental health condition at the same time?
Sure can! ADHD is highly co-morbid (occurs concurrently) with other mental health conditions.
ADDitude reported that approximately 60-70% of adults with ADHD also have:
An anxiety disorder (50%)
This includes social anxiety/social phobia (30%) and post-traumatic stress disorder (12%),
A mood disorder, such as depression or bipolar disorder (40%), and/or
A substance use disorder (15%).
ADHD in Adulthood: Treatment and Tips
Cool, cool, cool. I think I may have ADHD. How treatable is it and how do I get treatment?
Consulting with a psychiatrist, primary care physician, or a qualified mental health provider (e.g., psychologist, mental health counselor, social worker, or marriage and family therapist) is the first step to confirm diagnosis through assessment (verbal or written).
While there may not be a “cure” per se, ADHD is totally treatable and manageable. A combination of medication and therapy is typically most effective.
Most people find that medication is necessary to help manage their brain activity. Medication helps the brain function more effectively, supporting focus/concentration and reducing impulsive behaviors.
Medications for ADHD will be prescribed by a psychiatrist (doctor specializing in mental health conditions), medical doctor, nurse practitioner, etc. As with any medication, there may be certain conditions that may have bad reactions (including death) to certain medications so it’s important to consult your physician before taking medications (read: don’t try your friend or family member’s medication).
There are two types of prescription medications for ADHD:
Methylphenidates (Concerta, Ritalin, Daytrana, etc.)
Amphetamines (Ritalin, Vyvanse, etc.)
Strattera, Intuniv, Clonidine, and other medications primarily used for other conditions (such as certain anxiety/depression medications, certain blood pressure or anti-seizure medications) can also be effective for treating ADHD
Additionally, your doctor may find through blood tests that you may be deficient in certain vitamins or minerals, or that you may otherwise benefit from supplements. Common supplements could include Vitamin D, B-complex, Omega-3, and more.
Therapy is also super important. Mental health professionals, such as psychologists, mental health counselors, social workers, or marriage and family therapists will use their training, experience, and proven techniques to help. Therapy can help you adjust unhelpful thoughts and behaviors, improve self-esteem, learn more effective communication skills, improve relationships, and more.
What are some tips for helping manage my ADHD symptoms?
Create and follow routines that work for you.
Little tricks can help and become routines, such as putting calendar items in your calendar immediately; setting alarms (a little earlier if needed); putting your key items like keys, purse/wallet, sunglasses in the same place immediately upon returning home; packing your bag the night before
Get and stay organized.
Try out different organization techniques and find what works for you.
Remember that it’s easier to keep up with your organization than to let it go awry and struggle to get it back in line.
Create an effective workspace for you and minimize distractions which will call your attention elsewhere, such as TV.
Use apps which help you limit your access to electronic distractions.
Put on background music (classical music helps concentration and productivity) which can help drown out external noises.
Manage your time and brain power by taking reasonable breaks.
Breaks may look different. For instance, you may set a timer to work for 20 minutes and then take a five-minute break (set an alarm so you don’t lose track of time/get distracted on your break) then work another 20 minutes and so on. On the other hand, you may make an “agreement” with yourself that you’ll respond to five emails, then take a five-minute break.
Have an accountability partner.
Letting someone else know what your schedule, task-management plan, deadlines, etc., are can help you stay on-track with your plans.
Use active listening.
Active listening is a helpful set of skills which can help you stay more “checked in” when conversing with someone else and ensuring that you have a better understanding of what’s being discussed.
Rewards may be different for each person. For instance, you could give yourself a “job well done” internal pep-talk when you’re on-track, you could take yourself out for a nice meal, or treat yourself with a snack.
Use helpful self-talk.
Talk to yourself like you would your best friend. Be your own cheerleader by using motivating self-talk. Be compassionate with yourself when you make mistakes.
Remind yourself of why you’re doing things – and the why can simply be that you’ll feel better once the task is done or because you want that reward.
Practice mindfulness or meditation.
Mindfulness is slowing down and taking in your present moment.
Meditation -- I know… right now you’re saying that you “can’t meditate.” I get it! Actually almost everyone struggles with quieting their mind. Meditation isn’t necessarily having an absence of thought, but instead a quieting of thoughts or gentle focusing of your thoughts/attention. I recommend using guided meditation apps or other tools that can help you.
Care for your holistic wellness.
Having healthy social interactions, outlets for your energy (e.g., sports, physical activity, light stretching), tending to spiritual wellness, and so on can do wonders for your attention.
Sleeeep. Practice healthy sleep hygiene techniques.
Medication management from a physician and therapy with a mental health professional is key.
Life coaches or job coaches can also be helpful for establishing routines which are helpful.